Diffusion-Weighted Magnetic Resonance Imaging with Apparent Diffusion Coefficient Measurement for Monitoring and Early Tumor Response Prediction During Lymphoma Chemotherapy

Objective. To determine usefulness of diffusionweighted magnetic resonance imaging (MRI-DWI) with calculation of the apparent diffusion coefficient (ADC) for monitoring and early prediction of tumor response during chemotherapy (ChT) of lymphoma. Materials and Methods. Study included 25 patients with Hodgkin lymphoma and 26 patients with non-Hodgkin lymphoma (NHL). Whole body DWI-MRI was performed before and after ChT. MRI-DWI at the level of target lesion was performed after 1 cycle, before and after 2 cycles of ChT. The largest not necrotic lymph node was chosen as a target lesion. Built-in coil was used for whole body DWIMRI, surface and built-in coils were used for DWI-MRI of the target lesion. Results. During lymphoma ChT tumors decrease in size and ADC increases rapidly, to the maximum extent after 1 cycle of ChT. Earliest ADC increase was recorded on day 3 after the start of ChT. At subsequent stages of treatment ADC increase is slowing down. In case of tumor progression ADC decreases. In NHL target lesion ADC increase before 2nd cycle of ChT >37% predicts adequate response after 2 cycles with sensitivity of 93%, specificity of 90% and an accuracy of 92%. In patients with complete tumor response after ChT mean pre-treatment target lesion ADC was significantly lower (0.65 ± 0.15 ⋅ 10^-3 mm²/s) than in patients with non-complete response (0.94 ± 0.39 ⋅ 10^-3 mm²/s; p <0.05). Pre-treatment ADC ≤ 0.88 ⋅ 10^-3 mm²/s predicts complete response after ChT with a sensitivity of 100%, specificity of 50% and accuracy of 77%; an increase of ADC after the 1^st cycle >25% - with a sensitivity of 83%, specificity of 67% and an accuracy of 75%. When two parameters are used combined prediction accuracy increases to 83%. ADC values obtained using the built-in coil showed a lower prognostic properties compared with the values obtained using a surface coil. Conclusions. MRI-DWI can be used as a non-irradiative method of monitoring and early tumor response prediction during lymphoma ChT. ADC is a sensitive biomarker of tumor regression and progression in lymphoma.

диффузионно-взвешенная магнитно-резонансная томография, химиотерапия лимфом, регрессия опухолей, раннее прогнозирование, мониторинг лечения, diffusion-weighted magnetic resonance imaging, lymphoma chemotherapy, tumor response, early prediction, treatment monitoring

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